A Dose of Her Own Medicine

Written by Rosalind Fournier Photo by Beau Gustafson

When she describes the work that has evolved into her life’s passion—understanding what makes cancer treatments tick—Janet Houghton, PhD, the Emil Hess Endowed Chair in Cancer Biology at Southern Research, effortlessly rattles off sentences that regular smart people can’t begin to follow. Like other cancer researchers, drug developers and oncologists who populate labs and cancer centers around the world, Houghton has an innate determination to find and expose cancer’s Kryptonite.

Unlike most of them, she’s now played the role of both cancer scientist and survivor. To fight the disease, she’s literally taken her own medicine—specifically, 5-fluorouracil and leucovorin, two of the very drugs that she’s worked with extensively over her career. Along with the anticancer drugs oxaliplatin and Avastin, the cocktail recommended by her oncologist, Dr. John Piede at Alabama Oncology at St. Vincent’s Hospital, she credits the drugs she helped develop with saving her life.

Confronting the C Word

Last spring, Houghton sought medical attention for what she thought might be a hernia, brought on by too much heavy lifting during her move to Birmingham just a half year earlier. She learned instead that she was swollen with ascites fluid, a hallmark of cancer. A subsequent biopsy revealed stage IV appendiceal cancer—a malignancy so rare that fewer than approximately 2,500 cases are diagnosed each year. Naturally, her reaction was less that of a brilliant cancer researcher than simply a patient in shock. “Quite honestly,” Houghton says, “there wasn’t much hope at that point in time.”

The irony seemed particularly cruel. With her new position at Southern Research, she appeared better poised than ever to build on her life’s work with new, groundbreaking discoveries. Instead, Houghton found herself preparing for the fight of her life.

Houghton grew up in a small village called South Witham, about 100 miles north of London. Drawn from an early age to the sciences, Houghton excelled in school and eventually earned a degree from the University of Bradford College of Pharmacy and then her PhD in Cancer Research from the Institute of Cancer Research at Sutton. In 1977 she was recruited by St. Jude Children’s Research Hospital in Memphis, where she spent the next 29 years of her career, some of it studying the drug 5-fluorouracil and how it works against colon cancer. She and other investigators were also instrumental in advancing the concept that pairing the drug with leucocovorin could trigger enhanced DNA damage to cancer cells.

Houghton later moved to Cleveland Clinic to focus on how to fight colon cancer in adults. Nine years later, she accepted an offer at Southern Research, where she concluded she would have almost unheard-of resources at her fingertips to conduct drug discovery initiatives. “It was apparent very quickly,” she says, “this for me would be a perfect fit.”

It was just six months after joining the team here that Houghton learned she was facing a potentially terminal disease. “First, I think you go through a period of being in denial,” she says, “because you can’t believe you’ve been diagnosed with this. You think, ‘This can’t be right.’ And then I had to come through a period of acceptance that much of it was out of my control, and I would have to accept my fate, whatever it would be.” She remembers nights were the hardest, when her thoughts were free to roam to the darkest places.

Yet it wasn’t long before “accepting her fate” became the last way anyone would describe Houghton’s approach to her treatment. Cancer was a problem to be solved, and she intended to give it everything she had.

Once she had a definite diagnosis and a treatment plan in place, she told her daughters, now in their 20s, what was happening. She put her finances in order. “And then I did what I had to do,” Houghton says. “which was take the emotion out of it, because that can cloud your judgement. And then I tried in a really coldhearted way just to look at it as an interesting case.”

Plotting a Course of Treatment

Piede, in fact, who’s now become a friend, never really witnessed Houghton’s initial shock and denial. “Janet is so stoic,” Piede says, “and if she has any anxiety, she has not demonstrated it to me. From the moment of diagnosis, she has been with blinders on moving forward to the next step to be as successful as possible, and she doesn’t let anything get in her way.”

That alone might have been enough to tip him off that Houghton was going to be an unusual patient, but her knowledge and history with the drugs that would become so integral to her treatment were clearly the larger story. After all, this is a patient who had arrived at one appointment armed with several of her own scientific papers about the same cancer-fighting agents he was recommending for her treatment. (While Houghton’s focus has been on drugs targeting colon cancer, cancer of the appendix is so rare that treatment is often borrowed from the same protocol used to treat colon cancer, a close relative.)

“It was actually quite fascinating, because clearly this was the first time I’ve ever encountered that scenario,” Piede says. “She may be one of the few if not the only person in the world who has a story like that. How many times do we as oncologists meet somebody who actually developed the drugs that she’s receiving? And also, thankfully, see them work successfully? It gives me goose bumps when I think about it.”

Piede adds that as doctor and patient, he and Houghton were able to combine her intimate understanding of the drugs’ development with his experience in how they’re applied clinically in patients. “So to have both of us walk through this journey together is quite fascinating,” he says. “There are things she understands that I don’t, but then she would ask questions that typical patients wouldn’t ask—dosing, why we administer it the way we do, what are the toxicities if we go outside those parameters?”

Piede, in turn, graciously accepted that Houghton was going to seek as many opinions as possible—not just in the beginning, but throughout the process—as they continued to make decisions about every step in her treatment. “Janet knows everybody who knows everybody in the community,” he explains. “So she was very thorough. I think we kind of started joking when she got her eighth or ninth opinion on what to do, but once she found out that among other experts and myself, these recommendations started to come together in a unanimous or at least majority-type of decision, then we’d proceed forward.

“But she’s very proactive,” he continues. “Clearly the initiative that made her successful in research has made her successful as a patient, because she has sought every opportunity, option, and opinion to help her decide what’s the best decision for her and her treatment.”

Because it’s so rare, the treatment protocol is for appendiceal cancer is often based on treatment for colon cancer, a close relative. That meant Houghton—for better or worse—was going to experience the effects of the very colon-cancer drugs she’d been working on, and as a bit of a guinea pig, too. While these therapies had been used to treat cancer originating in the appendix before, there were too few documented cases to yield much solid data on the results.

What they did know was they needed to act quickly, and Houghton began chemotherapy treatments almost right away. For six months, it was fairly intense, though she tolerated it better than most—continuing to work most days, which she believes was far better for her than the alternative. “I think there are merits to having responsibilities where you have to be somewhere,” she says, “because you’re responsible for certain things, and I look at that as being instrumental in keeping me grounded.” She also credits her husband, who came with her to every doctor appointment, providing not only moral support but an extra pair of ears to keep up with the onslaught of information and instructions throughout her treatment.

Beyond all that, Piede strongly believes Houghton has been an exceptional patient due to her history of good health. “She tolerated the treatment beautifully with very minimal toxicity,” he says. “I think a lot of that is she’s taken care of herself her whole life; she was healthy and focused on her health outside of her cancer before, during and now after. So much of it was also mental. She has incredible mental fortitude and persistence.”

Meanwhile, Houghton was looking beyond chemotherapy to surgical options to make sure she was giving herself the best possible chance at beating the disease. Dr. Tina Wood, a now-retired oncologist from the University of Alabama at Birmingham, recommended Dr. David Bartlett at the University of Pittsburgh Medical Center. Bartlett and his team agreed that her cancer had responded amazingly well to the chemotherapy and were ready to proceed with what Houghton describes as a “radical” surgery to help finish the job. Houghton was ready to sign on—with a caveat. “Dr. Bartlett wanted to do the surgery three months in,” she remembers, “and I said, ‘Well, I’ve had such a dramatic response to chemotherapy, I’d like to finish the 12 cycles. If I can obtain another 90 percent response, that will be much better for me and much better for you, making the surgery less complicated.”

So on November 11, she went in for surgery. She had a spinal block and went through all the preparations, and the team was ready to go. “And between the two surgeons—Dr. Bartlett and his junior colleague—they couldn’t find any cancer to resect. The only thing they found was a tiny nodule, which they removed, and it had some scattered cancer cells. The rest of the biopsies they took came back negative.” There would be no surgery. When Piede herd the news, he says he was “flabbergasted but also just incredibly pleased.”

For her part, Houghton feels like one of the luckiest people alive. “I feel like I’ve resurrected myself, somehow,” she says, with a fleeting grin of the cat who just ate the canary. “I came back from having a very serious illness. And maybe the oncologists will challenge me on this, but I think I have a really good opportunity for not only long-term survival but a cure.” She continues to stay on maintenance chemotherapy for the time being—perhaps a year or two, or maybe indefinitely, but Houghton is okay with that. She feels great, appearing for an interview looking like the rock star she aspires to be in her spare time. She’s a talented keyboard player, currently taking voice training, and planning to join a band. She ticks off a list of potential genres (“classic rock, Southern rock, contemporary rock, some blues, top 40, anywhere I can find a niche”) with all the enthusiasm of a woman with a new lease on life, and why not?

Of course, her research remains her passion, now more than ever, and she’s back at it full force. “I think I have some really good ideas for new targets. I’m very optimistic that I can use my 40-year knowledge base to help discover and develop these new agents.

“As far as my story,” she continues, “I really want to give hope to patients who, on the outset, feel they’re facing what seem to be unbeatable odds. And that’s how I approach life—you mustn’t lose your spirit, because life continually throws things at you. So I’m planning to continue doing this as long as I can, and I’m very optimistic for what we can achieve here.”